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Risks and Requirements for Laboratories in Revalidation & Failure to Disclose

Risks and Requirements for Laboratories in Revalidation & Failure to Disclose. What is Medicare Revalidation?. All Medicare providers must verify their enrollment information & confirm they meet applicable standards

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Risks and Requirements for Laboratories in Revalidation & Failure to Disclose

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  1. Risks and Requirements for Laboratories in Revalidation & Failure to Disclose

  2. What is Medicare Revalidation? • All Medicare providers must verify their enrollment information & confirm they meet applicable standards • Within the next 24 months, approximately 1.5 million providers are going to receive revalidation notices • After 2015, providers must revalidate with Medicare every 5 years.* • *DMEPOS are required to revalidate every 3 years Page 2

  3. What does it mean for Labs? • Every laboratory will have to revalidate its enrollment • All laboratory clients will have to revalidate their Medicare enrollment • Untimely or incomplete submission can lead to deactivation of enrollment • Information supplied will be used for on site visits Page 3

  4. What About Medi-Cal? • “The Department of Health Care Services (DHCS) is in the process of establishing the required legal authority for implementation of the Final Rule. DHCS is also working towards developing policies and procedures to implement the new requirements of the Final Rule as directed by CMS in the periodic CMS Information Bulletins. Further communication concerning the progress of DHCS’ implementation of the new Federal Regulations will be published on the DHCS and Medi-Cal websites.” Page 4

  5. Consequences of Failure to Respond or Disclose • Deactivation • Temporary Suspension • Bar from participation • Procedure Code or Program Limitations Page 5

  6. Resources • Internet-Based PECOS - https://pecos.cms.hhs.gov/pecos/login.do • Medicare Revalidation List - https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Revalidations.html • Payment of Revalidation Application Fee - https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do Page 6

  7. CMS Medicare Learning Network Enrollment Updates • Revalidation requirements. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1126.pdf • Enrollment, fees and hardship exceptions. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7350.pdf Page 7

  8. Dawn Brewer, Esq.LAW OFFICES OF DAWN BREWER4640 Admiralty Way, Suite 500Marina del Rey, CA 90292(310) 442-9530(310) 943-1880dawn@dbrewerlaw.com Page 8

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